Adult Urinary Tract Infection (UTI)

If you have been advised by the surgery to submit an Adult Urinary Tract Infection (UTI) review please use this form.

Adult Urinary Tract Infection (UTI)

Section

What is your smoking status? *
Would you like information to help you quit?
Is there a burning / stinging when passing urine? *
Is the urine cloudy, is there any odour? *
Has the urine changed colour? *
Is there any blood in the urine? *
Do you have a fever? *
Do you have vaginal discharge (if applicable)?
Are you passing urine more often? *
Have you had a urine infection recently or a past history of recurrent urine infections? *
Do you have any of the following? (Please select all that apply)